Elsevier

Brain and Development

Volume 31, Issue 7, August 2009, Pages 537-544
Brain and Development

Review article
Cerebral palsy update

https://doi.org/10.1016/j.braindev.2009.03.009Get rights and content

Abstract

A common language on CP has been developed for the European registers by the SCPE (Surveillance of Cerebral Palsy in Europe) working group and the common database allows prevalence analyses on a larger basis. CP prevalence increases with lower birthweight and higher immaturity. Increase of survival after preterm birth has first also increased CP rates. But already in the 80s this trend was reversed for LBW infants, and in the 90s also for VLBW or very immature infants. The outcome with respect to CP in the group of extremely LBW or immature infants remains a matter of specific concern, as prevalence seems to be rather stable on a high level. CP is caused in more than 80% by brain lesions or maldevelopments which can be attributed to different timing periods of the developing brain. Extent and topography determine the clinical subtype of CP and are related also to the presence and severity of associated disabilities. CP, thus, offers a model to study plasticity of the developing brain. Reorganisation following unilateral lesions is mainly interhemispheric and homotopic. In the motor system, it involves the recruitment of ipsilateral tracts; functionality seems to be limited and decreases already towards the end of gestation. There is no clear evidence for substantial reorganisation in the sensory system. The best compensatory potential is described concerning language function following left hemispheric lesions. Language function reorganized to the right hemisphere eventually seems not to be impaired, this occurs, however, on the expense of primary right hemispheric functions.

Introduction

Cerebral Palsy (CP) is the commonest cause of physical disability in early childhood.

Overall, the CP rate is between 2 and 3 per 1000 livebirths. This rate increases to 40–100 per 1000 livebirths among babies born very early or with very low birthweight [1]. The disabling condition is permanent during the life of the affected children.

There is a high interest to monitor CP rates as a measure for pre-, peri and neonatal care and many countries run registers (population based). Monitoring cerebral palsy prevalence rates is important for instance in order to ensure that the increasing survival rate in very preterm babies is not at expense of an increasing “morbidity” rate.

When studying CP rates in low birthweight (LBW) or preterm born children, and looking at studies from a single centre or country, results reported are rather inconsistent. There are reports on an increase of the CP rate in very LBW (VLBW) children [2], [3], [4], and rates in extremely LBW (ELBW) children are reported as increasing or high [5], [6], [7]. But decreasing rates are also reported in VLBW [8], [9], [10], [11], [12], even in ELBW children [13]. The periods concerned are the late 80s and 90s especially. Because of different in- and exclusion criteria different ages at follow-up and the fact that not all of these studies were population based, these results are difficult to compare and to interpret. But overall, the CP rate in VLBW children is usually considered as not changing or rather increasing.

Section snippets

A common language on CP: SCPE – Surveillance of Cerebral Palsy in Europe

In 1998 a group of European epidemiologists and clinicians holding registers or doing population based studies established a network, the SCPE. It is the largest international collaboration of CP registers and surveys in the world and comprises at the moment 16 registers from nine countries across Europe.

Its main aim was to develop a central database of children with cerebral palsy in order to monitor trends in birthweight specific rates, to provide information for service planning and to

Prevalence studies from the common SCPE data base

Around half of the children with CP are term born (55% have a GA of 37 weeks or more), 20% have a GA of 32–36 weeks and 25% are below 32 weeks of gestation (relying on 9701 cases from the SCPE database covering the birth years 1977–1996). Eighty eight percent have a spastic CP (58% bilateral, 30% unilateral) and 7% a dyskinetic, 4% an ataxic CP, and 1% were not classifiable.

One-third of these children (30%) are unable to walk, defined at the age of 5 years. One-third (30%) have a severe

Pathogenesis of CP and the role of neuroimaging

Neuroimaging plays a decisive role in characterizing the ‘non-progressive lesion or abnormality of the developing/immature brain’ (part of CP definition) causing CP. Especially Magnetic Resonance Imaging (MRI) has been systematically studied in children with CP, thus, at a time when the clinical diagnosis was established, and has been shown to have a good potential to visualize lesions or maldevelopments of the brain [28].

In a systematic review of papers published in English between 1990 and

CP a model to study the young brain’s plasticity

As discussed above, CP is a condition which is mainly due to brain lesions which are characterizing pathogenic events at different times during early brain development, and, thus, offers a proper model to study compensatory mechanisms of the developing brain. The compensatory potential of the young nervous system following brain injury is considered to be superior to that of the adult brain [32].

Conclusion

A common language on CP: A common language on CP has been developed for the European registers by the SCPE (Surveillance of Cerebral Palsy in Europe) working group and the common database allows prevalence analyses on a larger basis.

Cerebral palsy prevalence: Cerebral palsy prevalence increases with lower birthweight and higher immaturity. Increase of survival after preterm birth has first also increased CP rates. But already in the 80s this trend was reversed for LBW infants, and in the 90s

Acknowledgement

This paper was presented at the third German-Japanese Symposium of Pediatric Neurology on September 2008, Munich, Germany.

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